Abstract
When prescribing a drug for a patient, a physician also has to consider economic aspects. We were interested in the feasibility and validity of profiling based on funnel plots and mixed effect models for the surveillance of German ambulatory care physicians’ prescribing. We analyzed prescriptions issued to patients with a health insurance card attending neurologists’ and psychiatrists’ ambulatory practices in the German federal state of Saarland. The German National Association of Statutory Health Insurance Physicians developed a prescribing assessment scheme (PAS) which contains a systematic appraisal of the benefit of drugs for so far 12 different indications. The drugs have been classified on the basis of their clinical evidence as “standard”, “reserve” or “third level” medication. We had 152.583 prescriptions in 56 practices available for analysis. A total of 38.796 patients received these prescriptions. The funnel plot approach with additive correction for overdispersion was almost equivalent to a mixed effects model which directly took the multilevel structure of the data into account. In the first case three practices were labeled as outliers, the mixed effects model resulted in two outliers. We suggest that both techniques should be routinely applied within a surveillance system of prescription claims data.
Highlights
When prescribing a drug for a patient, a physician has to consider the individual needs of a patient, the severity of her/his condition, the characteristics of suitable drugs and potential interactions with simultaneously prescribed treatments, and economic aspects
For this analysis we focus on drugs prescribed by psychiatrists and neurologists in the Saarland, one of the 16 German federal states combining both urban and rural characteristics
Average, every patientthan received were older than years
Summary
When prescribing a drug for a patient, a physician has to consider the individual needs of a patient, the severity of her/his condition, the characteristics of suitable drugs and potential interactions with simultaneously prescribed treatments, and economic aspects. For many indications several treatment options exist. Among these, prescribing physicians are expected to choose the less costly ones in order to preserve the economic viability of the health care system. The success of treatments should not be compromised. Prescribers are expected to balance quality and costs when prescribing treatments for their patients. In the German health care system this is a requirement based on federal law [1]
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